Abstract: New Onset of Crohn's Disease During Treatment of Active Ankylosing Spondylitis with Etanercept

New Onset of Crohn's Disease During Treatment of Active Ankylosing Spondylitis with Etanercept

IN-HO SONG, HEINER APPEL, HILDRUN HAIBEL, CHRISTOPH LODDENKEMPER, JURGEN BRAUN, JOACHIN SIEPER, and MARTIN RUDWALEIT

ABSTRACT. We describe 3 AS patients treated with etanercept for active AS who developed new onset of CD while AS related symptoms responded well to etanercept. Typical symptoms of active CD occurred 11, 12, and 26 months after start of etanercept therapy, respectively. On colonoscopy, inflammatory lesions highly compatible with CD were found endoscopically and histologically in all patients. Etanercept was stopped, and CD responded well to standard treatment. One of the 3 patients was reexposed to etanercept later on. While the 2 patients without re-exposure to etanercept did not have further CD flares, the third patient flared 6 months after re-institution of etanercept in combination with azathioprine. New onset of CD may be considered as an immune-mediated injury induced by etanercept. Although this is an intriguing hypothesis, any causative role of etanercept remains unproven at this stage. (First Release Jan 15 2008; J Rheumatol 2008;35:532–6)

Key Indexing Terms:

ETANERCEPT
CROHN'S DISEASE
SIDE EFFECTS
ANKYLOSING SPONDYLITIS
TUMOR NECROSIS FACTOR-a INHIBITORS
GRANULOMA FORMATION

From Department of Rheumatology, Division of Medicine, and Institute for Pathology/Research Center ImmunoSciences (RCIS), Charité Medical University, Campus Benjamin Franklin, Berlin; and Rheumazentrum Ruhrgebiet, Herne, Germany.

I-H. Song, MD, Rheumatologist; H. Appel, MD, Rheumatologist; H. Haibel, MD, Rheumatologist; J. Sieper, MD, Professor of Rheumatology; M. Rudwaleit, MD, Consultant Rheumatologist, Department of Rheumatology; C. Loddenkemper, Professor of Inflammatory Pathology, Institute for Pathology/Research Center ImmunoSciences (RCIS), Charité Medical University, Campus Benjamin Franklin; J. Braun, MD, Professor of Rheumatology, Rheumazentrum Ruhrgebiet.

Address reprint requests to Dr. M. Rudwaleit, Charité, Campus Benjamin Franklin, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail: martin.rudwaleit@charite.de

Accepted for publication October 1, 2007.